Organization
SOUTHGATE MEDICAL PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR JOHN LUCCI RPH (SUPERVISING PHARMACIST)
(716) 712-0630
Entity
Organization
Contact information
Practice address
1026 UNION RD, WEST SENECA, NY 14224-3449
(716) 712-0630
(716) 712-0633
Mailing address
1026 UNION RD, WEST SENECA, NY 14224-3445
(716) 712-0630
(716) 712-0633
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
025883
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02408148
—
NY
Enumeration date
01/26/2007
Last updated
02/28/2021
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